Clinical ethical dilemmas for vascular surgeons (The vascuethics study) : are self-interest attitudes related to profeccional seniority

Producción CientíficaObjective. To evaluate the association between professional seniority and self-interest (PSI) attitudes in the resolution of vascular ethical dilemmas (VED). Design. Cross-sectional. Subjects. Vascular surgeons (residents included) from the 28 vascular teaching departments of Spain. Measurements. Multidisciplinary team-designed questionnaire of 5 VED. Each VED had 3 different answers (attitudes): 2 favouring legitimate ethical attitudes (LEA) and 1 favouring PSI. The questionnaire was self-administered and all participants stated their degree of agreement with each answer on a continuous Likert scale. PSI was evaluated by: (1) adding the magnitudes of the 5 answers favouring PSI (absPSI); and (2) by comparing in each case the magnitude of the PSI answer with that of the 2 LEA (relPSI). Statistics. Linear regression adjusted by confounding factors. Results. Two hundred and fifty-three vascular surgeons from the 26 participating teaching vascular departments of public hospitals completed the questionnaire (87.5% surgeons/department). Surgeon characteristics were: (1) median age 37 years; (2) 187 (74%) male; (3) 59 (23%) brought up with a health professional relative; (4) 94 (38%) had additional private practice; (5) 133 (65%) professed religious beliefs; and (6) 1–10 years of experience in 116 (47%), 11–20 years in 58 (24%), 21–30 years in 57 (23%), and .30 years in 15 (6%). The multivariate analysis disclosed that for every 10-years rise in professional seniority there was a 3.2% increase in absPSI (p ¼ 0.007, adjusted by variables 3 and 4), and a 3.4% increase in relPSI (p ¼ 0.002, adjusted by variable 5). Conclusions. Professional seniority is associated with a slight increase in pro-PSI attitudes in cases of vascular ethical dilemma. Both vascular surgeons and health institutions should promote the reversal of this worrying tendency

Reframing the science and policy of nicotine, illegal drugs and alcohol - conclusions of the ALICE RAP Project.

In 2013, illegal drug use was responsible for 1.8% of years of life lost in the European Union, alcohol was responsible for 8.2% and tobacco for 18.2%, imposing economic burdens in excess of 2.5% of GDP. No single European country has optimal governance structures for reducing the harm done by nicotine, illegal drugs and alcohol, and existing ones are poorly designed, fragmented, and sometimes cause harm. Reporting the main science and policy conclusions of a transdisciplinary five-year analysis of the place of addictions in Europe, researchers from 67 scientific institutions addressed these problems by reframing an understanding of addictions.  A new paradigm needs to account for evolutionary evidence which suggests that humans are biologically predisposed to seek out drugs, and that, today, individuals face availability of high drug doses, consequently increasing the risk of harm.  New definitions need to acknowledge that the defining element of addictive drugs is 'heavy use over time', a concept that could replace the diagnostic artefact captured by the clinical term 'substance use disorder', thus opening the door for new substances to be considered such as sugar. Tools of quantitative risk assessment that recognize drugs as toxins could be further deployed to assess regulatory approaches to reducing harm. Re-designed governance of drugs requires embedding policy within a comprehensive societal well-being frame that encompasses a range of domains of well-being, including quality of life, material living conditions and sustainability over time; such a frame adds arguments to the inappropriateness of policies that criminalize individuals for using drugs and that continue to categorize certain drugs as illegal. A health footprint, modelled on the carbon footprint, and using quantitative measures such as years of life lost due to death or disability, could serve as the accountability tool that apportions responsibility for who and what causes drug-related harm

Assessing public leadership styles for innovation:A comparison of Copenhagen, Rotterdam and Barcelona

This article explores which leadership qualities public managers regard as important for public innovation. It is based on a survey of 365 senior public managers in Copenhagen, Rotterdam and Barcelona. Five perspectives on leadership were identified and tested using a number of items. Some of these proved to be more robust than others. Analysis of the three cities reveals a nuanced set of leadership styles, which include a transformational style, and one that is more dedicated to motivating employees, risk-taking and including others in decision-making. This suggests the need for more research on leadership and public-sector innovation

Genetic analysis of D-xylose metabolism by endophytic yeast strains of Rhodotorula graminis and Rhodotorula mucilaginosa

Two novel endophytic yeast strains, WP1 and PTD3, isolated from within the stems of poplar (Populus) trees, were genetically characterized with respect to their xylose metabolism genes. These two strains, belonging to the species Rhodotorula graminis and R. mucilaginosa, respectively, utilize both hexose and pentose sugars, including the common plant pentose sugar, D-xylose. The xylose reductase (XYL1) and xylitol dehydrogenase (XYL2) genes were cloned and characterized. The derived amino acid sequences of xylose reductase (XR) and xylose dehydrogenase (XDH) were 32%∼41% homologous to those of Pichia stipitis and Candida. spp., two species known to utilize xylose. The derived XR and XDH sequences of WP1 and PTD3 had higher homology (73% and 69% identity) with each other. WP1 and PTD3 were grown in single sugar and mixed sugar media to analyze the XYL1 and XYL2 gene regulation mechanisms. Our results revealed that for both strains, the gene expression is induced by D-xylose, and that in PTD3 the expression was not repressed by glucose in the presence of xylose

Improving Access to Mental Health Care in an Orthodox Jewish Community: A Critical Reflection Upon the Accommodation of Otherness

The English National Health Service (NHS) has significantly extended the supply of evidence based psychological interventions in primary care for people experiencing common mental health problems. Yet despite the extra resources, the accessibility of services for ‘under-served’ ethnic and religious minority groups, is considerably short of the levels of access that may be necessary to offset the health inequalities created by their different exposure to services, resulting in negative health outcomes. This paper offers a critical reflection upon an initiative that sought to improve access to an NHS funded primary care mental health service to one ‘under-served’ population, an Orthodox Jewish community in the North West of England

Monitoring quality and coverage of harm reduction services for people who use drugs: a consensus study.

BACKGROUND AND AIMS: Despite advances in our knowledge of effective services for people who use drugs over the last decades globally, coverage remains poor in most countries, while quality is often unknown. This paper aims to discuss the historical development of successful epidemiological indicators and to present a framework for extending them with additional indicators of coverage and quality of harm reduction services, for monitoring and evaluation at international, national or subnational levels. The ultimate aim is to improve these services in order to reduce health and social problems among people who use drugs, such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection, crime and legal problems, overdose (death) and other morbidity and mortality. METHODS AND RESULTS: The framework was developed collaboratively using consensus methods involving nominal group meetings, review of existing quality standards, repeated email commenting rounds and qualitative analysis of opinions/experiences from a broad range of professionals/experts, including members of civil society and organisations representing people who use drugs. Twelve priority candidate indicators are proposed for opioid agonist therapy (OAT), needle and syringe programmes (NSP) and generic cross-cutting aspects of harm reduction (and potentially other drug) services. Under the specific OAT indicators, priority indicators included 'coverage', 'waiting list time', 'dosage' and 'availability in prisons'. For the specific NSP indicators, the priority indicators included 'coverage', 'number of needles/syringes distributed/collected', 'provision of other drug use paraphernalia' and 'availability in prisons'. Among the generic or cross-cutting indicators the priority indicators were 'infectious diseases counselling and care', 'take away naloxone', 'information on safe use/sex' and 'condoms'. We discuss conditions for the successful development of the suggested indicators and constraints (e.g. funding, ideology). We propose conducting a pilot study to test the feasibility and applicability of the proposed indicators before their scaling up and routine implementation, to evaluate their effectiveness in comparing service coverage and quality across countries. CONCLUSIONS: The establishment of an improved set of validated and internationally agreed upon best practice indicators for monitoring harm reduction service will provide a structural basis for public health and epidemiological studies and support evidence and human rights-based health policies, services and interventions

What is governance?

The politics and administration of institutional chang

Executive Programs for the Public Sector: Taking Stock and Future Perspectives

The politics and administration of institutional chang